Looking After Yourself

Travel

Many women travel in pregnancy for work or holidays. For most women this is safe but there are some important issues you need to consider when making travel arrangements, particularly if you are travelling overseas.

Most airlines will let women fly internationally up to 34 or 36 weeks of pregnancy. You will need to check the exact cut-off date with your airline. They may require a letter from us confirming that you are fit to fly. In most cases flying up to this time is possible but may not be advisable for some women (for example if you are expecting twins or are likely to give birth prematurely).

Importantly, travel insurance is very hard to obtain after 28 weeks of pregnancy and this effectively rules out overseas travel for most women after this time. Having to consult medical help or arrange repatriation from overseas without insurance can cost you tens of thousands of dollars.

All travellers have a very small risk of developing blood clots and thrombosis in their legs or lungs when taking long flights. This risk is greater for women who are pregnant. Do discuss your travel plans with us so we can advise whether any special precautions need to be taken.

Travel within New Zealand is usually safe until close to your due date but do remember that some women will go into labour early and if you are far from Auckland in late pregnancy you may need to give birth in another hospital.

Wherever you are travelling it is worth checking in advance who you might be able to see locally if you have any medical problems. For some couples this may be their relatives’ family doctor. Otherwise your resort or hotel should be able to tell you where a local doctor can be found. Do remember that in many countries local medical facilities are a lot less developed than the local tourist industry.

If you are overseas and under our care, you can call for advice at any time. If easier you can also email us but it may take a day or two for us to reply.

Air travel does not increase your risk of miscarriage. However, miscarriage is fairly common and you may prefer not to be overseas in early pregnancy until you know all is well.

Many women work full time until as close as two or three weeks before their due date. However, most women start to feel quite uncomfortable working long hours and are sleeping poorly from as early as 32 weeks. Remember this pregnancy is “all about you” - discuss with your employer whether working part time is possible in the last trimester. You will often work more efficiently if you work shorter hours or work from home for part of the week. Do discuss with us when the best time to give up work might be. We can provide you with a letter to confirm your due date so you can arrange maternity leave.

Exercise

Ideally, you should aim for 20 to 30 minutes of moderate physical activity every day. This may just mean parking the car further from work or making time with your partner or a friend to go for a walk each morning or evening. Many women have very sedentary jobs and work long hours in pregnancy so it is important to make time to stay fit. Find whatever activity you enjoy most. Build some activity into your working day with stairs, a walk to lunch, or some midday exercise.

There are also many exercise classes and fitness activities aimed specifically at pregnant women and it is well worth making time to attend a regular class.

If you exercised regularly before pregnancy you can safely continue throughout your pregnancy. You may need to reduce both the intensity and duration of your exercise programme. In the first trimester, fatigue may make regular exercise difficult and later on a change in your body shape or an increase in your breast size may also make some sorts of exercise and sport difficult.

There are very few sports or exercises that are dangerous during pregnancy but you will find that your balance changes making accidents more common and your “stretchier” ligaments will also be more prone to injury. Do talk to us if you are concerned about your exercise programme or any particular sporting activity during your pregnancy.

You can read some useful guidelines on exercise in pregnancy here. Our Useful Websites and Information page also has the contact details for a range of pregnancy fitness activities and classes.

Diet and weight gain in pregnancy

Your pregnancy will progress well with only very small increases in your intake of protein, carbohydrate, fat, vitamins and minerals. The digestive system in pregnant women changes and becomes more efficient at absorbing certain nutrients. With only a few exceptions, most of the additional nutrient needs of pregnancy can be met by eating a well-balanced and varied diet. ‘Eating for two’ certainly doesn’t mean you should eat twice as much food. Aim for a healthy balanced diet during your pregnancy. You can read the Ministry of Health guide to healthy eating in pregnancy here.

Pregnancy may be good time for both you and your partner to do more “home cooking” and cut back on the consumption of takeaways and junk food that full time work often necessitates.

Many women worry that they are gaining too much or too little weight during their pregnancy. Weight gain will vary and most healthy women will gain 11 to 16 Kg over their pregnancy (about 0.4 Kg per week during the second half of their pregnancy). However, if you are overweight you should try to avoid excessive weight gain in pregnancy and we may advise you to limit your weight gain. If you are significantly overweight (have a BMI of over 30) you should limit your weight gain to 5 to 9 Kg over your pregnancy. Excessive weight gain in pregnancy is associated with having a large baby, being delivered by caesarean section, high blood pressure and developing diabetes in pregnancy (gestational diabetes). You can read a useful short guide to weight gain in pregnancy from the Ministry of Health here.

Food Safety

Most food you prepare at home will be safe to eat in pregnancy so don’t worry - you can still eat well in pregnancy. More serious forms of food poisoning associated with miscarriage such as Listeria are actually very rare but women are more susceptible to all types of food poisoning when pregnant so it is important to obey some simple food hygiene rules. These are often called the four “C’s”: clean your hands when preparing food, cook your food well, cover any food to be stored and chill any food that you store after cooking.

Some foods should always be avoided in pregnancy but most food that is well cooked and hot will be safe. We will give you a useful information booklet from the Ministry of Health on foods to be careful with or avoid at your booking visit. You can also download the Ministry of Health booklet 'Food Safety in Pregnancy' by clicking here. Their 'Pull Out Guide to Food Safety' is available here.

Smoking

The best time to stop smoking is before you become pregnant because of the well-established risks to your developing baby. Smoking has been linked to poor growth in a developing baby and stillbirth. Many smokers find pregnancy the easiest time to give up. There are smoking cessation programmes based at National Women’s that are aimed specifically at supporting pregnant women trying to quit. We can arrange a referral for you. If your partner is a smoker, your pregnancy is a great time for them to stop smoking. The risk of cot death and childhood asthma is considerably greater if one or both parents smoke.

Coughs and Colds

Coughs, colds and sinusitis are common in pregnancy. Most women will not need antibiotics but a cold can take a lot longer to settle when you are pregnant. A two or three day long cold may last a week or two when you are pregnant and should be taken seriously. Take time off work to rest and recover. It is safe to take paracetamol to keep your temperature down but if you are feeling significantly unwell it is important that you call us or see you GP for advice.

Sleep on your side

After 28 weeks of pregnancy you should go to sleep on your side. When you lie on your back the womb and baby put pressure on the large blood vessels in you abdomen potentially reducing blood flow to your womb. Going to sleep on your side in the last trimester of pregnancy may reduce your risk of stillbirth by up to half. Don't worry if you wake up on your back-most women change position during sleep. The important thing is to start sleeping lying on your side and settle back to sleep on your side if you wake up. You can read more advice from the Ministry of Health here.

Influenza and whooping cough immunisation

Changes in your immune system during pregnancy mean that pregnant women are more susceptible to flu than non-pregnant women. Pregnant women with influenza are more than ten times more likely to be admitted to hospital or require treatment in an intensive care setting than women who are not pregnant. The influenza virus itself does not actually cross the placenta but there is some risk to your baby if you yourself are seriously unwell.

Seasonal influenza immunisation during pregnancy reduces the risk of you contracting influenza during your pregnancy. It also transfers some immunity to baby and will reduce the risk of your baby developing influenza during its first six months by 90%.

The influenza vaccination is an “inactive” vaccine and has been used in pregnant women for nearly 50 years. It is safe in all trimesters of pregnancy and is available at no charge as a funded immunisation for pregnant women. You can also reduce both your risk and your baby’s risk of catching influenza by ensuring your partner and family are immunised while you are pregnant.

You can have an influenza vaccination at any time during your pregnancy. You can read more information on influenza and pregnancy from the Ministry of Health here.

In recent years whooping cough has become a relatively common infection and infection rates in Auckland have increased dramatically over the last five years. It can be a serious infection in both adults and children with symptoms lasting for many weeks. The Ministry of Health both recommends and funds the whooping cough vaccine for women between 28 and 38 weeks of pregnancy. This protects you from catching whooping cough in pregnancy and reduces the risk of you infecting your new born baby.

You will also pass on some immunity to baby directly if you are immunised in the last few months of your pregnancy, protecting your baby against whooping cough for the first two months after birth. The best time to be immunised against whooping cough is between 30 and 36 weeks of pregnancy and the maximum benefit is thought to be if you are immunised between 31 and 33 weeks.

The whooping cough vaccine is safe and has been given in pregnancy for many years. It is recommended that you have a whooping cough immunisation every pregnancy to pass on immunity to your baby. You can also reduce the risk of your baby catching whooping cough by ensuring that other adult family members are immunised and older siblings are up to date with their immunisations. If your partner has not had a whooping cough immunisation in the last ten years it is a good idea for him to be immunised. There is a charge by your GP for this. You can read more information on whooping cough and pregnancy from the Ministry of Health here and consumer information on the whooping cough vaccine here.

In summary:

You should have an influenza vaccination every pregnancy and can have it at any time in your pregnancy.

You should have a whooping cough vaccination every pregnancy and ideally have it between 31 and 33 weeks.

Medication

Most prescribed medication is safe to take in pregnancy and women taking medication for a wide range of medical problems are likely to be able to continue their medication. However, it is important that you let us know what medication you are taking so this can be checked. Ideally, check with your prescribing doctor before you become pregnant or as soon as you have a positive pregnancy test if you have conceived unexpectedly. It is also important that you don’t stop essential medication in pregnancy without checking with us or your GP. If there is any concern about the safety of a particular drug in pregnancy there are usually safer alternatives available that can be prescribed.

Family Violence

Family violence is a common problem blighting the lives of many women and their families. We often see women with their partners for most of their appointments so this can be a difficult issue for women to bring up themselves. National Women’s Health is committed to reaching out to women affected by family violence and you may be asked screening questions about this if you are seen in clinics or on the wards at the hospital. Do call us or talk to us in confidence if family violence is an issue for you. You can also find out more information about getting help on our Useful Websites and Information page.